Muscle strains and tears
Let’s talk about muscle strains / tears.
You’re doing your thing and all of a sudden POP.
Now what…?
Especially when it is the first time it happens to you, it can be scary.
This blog outlines general guidelines in recovery from a muscle strain.
When you suspect you have a muscle strain or tear, visit a health care professional for an evaluation to get a proper diagnoses and recovery plan.
Let’s break it down and explore what you can to do optimize and speed up the recovery process.
What is a muscle tear?
Think of a rope stretched taut. As it is pulled harder, more and more patches shoot loose until the rope finally breaks. Something similar happens in your muscles, too. When the force coming onto a muscle is too great for what it can handle, it can (partially) tear. This can happen when you try to shorten a muscle, as well as when you stretch a muscle all the way (a strain).
Common muscle tears occur in the thigh, hamstrings, calf , as well as the shoulder (rotator cuff), upper arm (biceps/triceps) and low back. However, a tear or strain can happen in every muscles.
There are several ways to grade what kind of muscle strain or tears there are.
The most common grading system has 3 grades of muscle strains.
GRADES OF MUSCLE STRAINS
There are several ways to grade what kind of muscle strain or tears there are.
The most common grading system has 3 grades of muscle strains.
Grade 1: Localized pain, aggravated by movement; minor disability; mild swelling, ecchymosis, local tenderness; minimal hemorrhage.
Grade 2: Localized pain, aggravated by movement; moderate disability; moderate swelling, ecchymosis, local tenderness; stretching and tearing of fibers, without complete disruption.
Grade 3: Severe pain, and disability; severe swelling, ecchymosis, hematoma; palpable defect and loss of muscle function; muscle or tendon rupture
Depending on the severity of the sprain or tear you will experience pain, stiffness and it probably feels warm, inflamed, swollen and bruised. This is a normal and essential part of the recovery process.
Grade 1 sprains generally are recovered within 3-6 weeks and grade 3 tears(with surgery) might take up to 1-2 years to fully recover.
Lets dive into what happens on a physiological level.
There are 3 sequential but overlapping phases of tissue repair. First, the inflammation phase in the first 1-4 days, the proliferation phase 3-24 days after injury and the remodeling phase 21 days-2 years after injury.
PHASE 1: INFLAMMATION PHASE
The inflammation phase is your body’s way to assess the damage, clean the area and prep the wound for further repair.
Compare it to an accident happening. A lot of police and first responders arrive on scene, they close down the streets and traffic flow is significantly impaired. Once assessed and the debris is partially cleaned up, they slowly open the roads for traffic to resume.
In your body a similar process happens. When a tear happens, a lot of cells arrive on scene. Cells to kill pathogens and bacteria. Cells to ‘plug’ the wound, other cells to clean up damaged tissue. Growth factors, nutrients and enzymes also arrive and help to kickstart recovery. This inflammation phase generally lasts 1-3 days.
RICE OR NOT?
The advise used to be RICE (Rest, Ice, Compress, Elevate). However the Rest and Ice part might be better to skip.
Why skip Rest and Ice?
In order to recover, your cells need to receive nutrients and oxygen and need to send off waste products. The way to do that is through bloodflow. Bloodflow gets stimulated through movement. Resting, and thus, doing nothing, decreases circulation in the injured area. The better option is to start moving as soon as possible after your injury. Don’t push through the pain, but start with gently contracting the injured muscle and moving the joints above and below the injury, within the painfree range. Even small movements already stimulate bloodflow and thus recovery.
The reason for skipping Ice is that ice cools down the area. Even though if feels nice, cooling down the area actually hinders the inflammation process. The heat is needed to kill off any pathogens and harmful bacteria.
Compression and elevation are still good to do.
MOVEMENT IS THE BETTER OPTION
Like I mentioned before, movement is essential in the recovery process. When you start moving the injured muscle, you’ll probably notice that consciously contracting it is pretty hard to do. As a protection mechanism, your brain tightens up and ‘shuts down’ the injured muscle right after it happens. This happens to decrease the tension on the site of the wound.
I believe one of the most important things in this phase is to get back that awareness and ability to consciously contract a muscle.
When contracting the muscle or moving a joint is too painful, go for static (isometric) contractions (contract your muscle without moving). Start with 15 second holds in different angles and build that out. Also here, the goal is to get awareness back and stimulate recovery, not to push through pain.
Seeing a physio in this phase is advised. However you don’t want any treatment on the site of the injury. It is ok to gently treat the surrounding tissue. It can decrease the tension on the wound, making it easier to close down in the next phase.
Phase 2: Proliferation phase
The next phase after the inflammation phase, the proliferation phase.
During the proliferation phase the wound is closed down and repaired.
New cells (scar tissue) are being layed down and the edges of the wound are being pulled together so the wound can fully close.
During this phase you’ll notice that pain decreases and function improves (you can do more with the injured area). It is common to still have some symptoms even though it is weeks after your injury.
You do have to be conscious with the load you put on the tissue. A gentle and gradual build up of load is really important to allow the strength and flexibility to build up and prevent reinjury.
Phase 3: Remodeling phase
The remodeling phase is the last phase of tissue recovery.
During this phase, the injured tissue is reinforced en can handle bigger forces.
Even though the pain is mostly gone, the tissue is not at its full strength, flexibility, balance and reaction time yet.
Your rehab program should take these factors into consideration bases on your goals.
Other considerations and take aways
So now you know more about how tissue recovers after a tear. We’ve touched the subject of training and exercises too.
There are other things to consider as well.
- Recovery takes time.Recovering from injuries takes longer than most people expect. Don’t panic if you’re not 100% recovered after a few months. Tissue recovery can take up to 2 years after a bad sprain or tear. It’s normal.
- Sleep.You recover when you sleep. The bigger the injury, the more you should prioritize sleeping a minimum of 8 hours.
- Nutrition.In order to recover optimally from an injury your body needs the right nutrients. Add some protein to your diet and make sure you get enough vitamins in, preferably through food, but supplementation is also ok.
- Besides magnesium, omega 3, vitamin d3, you might benefit from antioxidants (vitamin A, C and E, zinc, selenium, glutathione) and collagen. When you are not a supplement person, bone broth is a great source of collagen, vitamines, minerals and aminoacids.
- Breathing.why would breathing influence recovery you might think. When injured, your body is put in a state of stress, but in order to heal optimally you will benefit from being in a more relaxed state. Breathing is one of the best tools to relax and switch to a more relaxed state to create an optimal environment for recovery. Focus on exhaling longer than you inhale. Do that 2x 10 minutes a day.
- Painkillers and anti-inflammatory drugs. Now you know that inflammation is essential in recovery so be mindful of using anti-inflammatory drugs. When in doubt, contact your GP.
- Movement.I’ve mentioned it before, but its worth to mention again. Getting movement back asap is essential in your recovery. Rest is outdated.
In each phase of the recovery there are things that you can do to speed up healing, stimulate your body to create a better recovery and prevent reinjury.
Our physiotherapists will be able to advise you on the right treatment and exercises to carry out at the right time for you.
We’ll also be able to help you to get you back on track when things are taking a bit longer than expected.
